Rauscher H, Formanek D, Popp W, Zwick H
Pulmonary Department, Krankenhaus Lainz, Vienna, Austria.
Thorax. 1993 May;48(5):529-33. doi: 10.1136/thx.48.5.529.
The high prevalence of obstructive sleep apnoea (OSA) in patients with systemic hypertension and of hypertension in patients with OSA suggests a causal link between the two disorders. This study was carried out to determine whether nasal continuous positive airway pressure (CPAP) and weight loss affect daytime hypertension in OSA.
Sixty hypertensive patients with OSA took part in the study; 33 accepted nasal CPAP and used their machine for 5.7 (0.2) hours per night, and the remaining 27 patients refused nasal CPAP and upper airway surgery so the only therapeutic intervention was a recommendation of weight loss. A significant change in hypertension during follow up was defined as either a change in mean blood pressure of at least 10 mm Hg (or more than 8%) without a change in drug treatment, or a reduction in drug dosage with mean blood pressure within these limits. Weight loss was defined as a body mass index of at least 5% below the baseline value.
After 512 (41) days, hypertension had become less severe in seven of 12 patients (58%) treated with weight loss only, in eight of 28 patients (29%) with nasal CPAP only, in two of five patients with nasal CPAP and weight loss, and in one of 15 patients without nasal CPAP or weight loss. Multivariate analysis of variance with the outcome of hypertension at follow up as the dependent variable revealed that only the percentage change in body mass index significantly contributed to the course of hypertension.
The course of hypertension in OSA is more closely linked to weight loss than to elimination of sleep apnoea by nasal CPAP.
系统性高血压患者中阻塞性睡眠呼吸暂停（OSA）的高患病率以及OSA患者中高血压的高患病率提示这两种疾病之间存在因果关系。本研究旨在确定经鼻持续气道正压通气（CPAP）和体重减轻是否会影响OSA患者的日间高血压。
60例患有OSA的高血压患者参与了本研究；33例接受经鼻CPAP治疗，每晚使用设备5.7（0.2）小时，其余27例患者拒绝经鼻CPAP和上气道手术，因此唯一的治疗干预措施是建议其减轻体重。随访期间高血压的显著变化定义为：在未改变药物治疗的情况下平均血压变化至少10 mmHg（或超过8%），或在平均血压处于这些范围内的情况下减少药物剂量。体重减轻定义为体重指数至少比基线值低5%。
512（41）天后，仅接受体重减轻治疗的12例患者中有7例（58%）高血压病情减轻，仅接受经鼻CPAP治疗的28例患者中有8例（29%）病情减轻，接受经鼻CPAP和体重减轻治疗的5例患者中有2例病情减轻，未接受经鼻CPAP或体重减轻治疗的15例患者中有1例病情减轻。以随访时高血压结果作为因变量的多变量方差分析显示，只有体重指数的百分比变化对高血压病程有显著影响。
OSA患者的高血压病程与体重减轻的关系比与经鼻CPAP消除睡眠呼吸暂停的关系更为密切。
